When should we treat non-group A streptococcal pharyngitis, e.g., group B, C, or G?
—Jeffrey D. Smith, MD, Lubbock, Tex.

To be safe, non-group A strep pharyngitis should always be treated. Penicillin is the treatment of choice for either B, C, or G streptococcal species. Non-group A streptococcal pharyngitis has been described with both group C and group G streptococci in some case series. Group C is probably “worse” than G, as it has been definitely associated with glomerulonephritis, but there are some circumstantial case reports implicating group G as well. Group B is not a usual pathogen associated with pharyngitis. Because it is typically more invasive and suppurative, its isolation in the posterior pharynx is not benign, as it could be a marker for invasive disease elsewhere close by, with abscess formation and local tissue destruction.
—Cedric W. Spak, MD, MPH

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